The book BAD BLOOD: THE TUSKEGEE SYPHILIS EXPERIMENT by James H. Jones was a very powerful compilation of years of astounding research, numerous interviews, and some very interesting positions on the ethical and moral issues associated with the study of human beings under the Public Health Service (PHS). â€œThe Tuskegee study had nothing to do with treatment â€¦ it was a nontherapeutic experiment, aimed at compiling data on the effects of the spontaneous evolution of syphilis in black malesâ€ (Jones pg. 2). Jones is very opinionated throughout the book; however, he carefully documents the foundation of those opinions with quotes from letters and medical journals. The book allowed the reader to see the experiment from different viewpoints. This was remarkable because of the initial feelings the reader has when first hearing of the experiment. In the beginning of the book, the reader will see clearly there has been wrong doing in this experiment, but somehow, Jones will transform you into asking yourself, â€œHow could this happen for so long?â€

Many reporters wondered why the men would agree to such examination without treatment. Jones points out the economical status of the 1930â€™s is one where the men were eager to attend because they received so much more than what they currently had during that time period. Free medical exams, free rides to the examinations, hot meals on exam days, free treatment for minor ailments, and a guaranteed burial stipend of a modest $50 in 1932 were all promised to the men for their involvement with these experiments (Jones pg. 4).

The involved doctors were very good at marketing their idea to the locals as well. During this time the Rosenwald Fund was initiated by Julius Rosenwald to assist in educating the African-Americans in the South by supporting the construction of schools for black students. Shortly after the withdrawal of the Rosenwald Fund, Dr. Taliaferro Clark, who was selected by the surgeon general as the reviewer of the Rosenwald Fund, realized the potential of the opportunity to study Macon County Alabamaâ€™s African-American males and sparked the idea of the Tuskegee Study of Untreated Syphilis in the Negro Male. This study was the longest nontherapeutic experiment on human beings in medical history (Jones pg. 91). Therefore, Jonesâ€™ purpose was to document the experiment in a way that the reader would see all points of view, yet still realize without doubt, the implications of this study.

Themes

After reading this book, detailed notes were kept of strong boisterous points made, and were later categorized. A majority of these points were categorized as â€œDECEITFUL.â€ It was apparent that Dr. Clark and Dr. Raymond Vonderlehr, Public Health Service officer selected to be in charge of the study, were both well adverse in what the public would agree to, and would not agree to. This is evident throughout the book; however, one particular instance that stood out in my mind the most was the selling of the idea to the African-Americans through the use of the schools and churches. Because of these locations, the African-American males felt safe because of their beliefs that the church would not condone anything that would hurt them. They also looked forward to the exam days because of the â€œsocial gatherings and a half day away from the fieldsâ€ (Jones pg. 69). Deceit also played a part in the selling of the study to the Plantation owners by reminding them of the earlier successes against such diseases as yellow fever, typhoid fever, and pellagra. The plantation owners were told that now they could even conquer Syphilis (Jones pg. 67).

Dr. Clark also took actions that were deceitful to his peers as well. In an article on the Rosenwald Fundâ€™s syphilis control demonstrations, he was careful to only circulate this article to people directly involved within the medical industry. This limited the amount of publicity in which the ethical issues were sure to be identified (Jones pg. 77). Dr. Clark was also careful in discussing the study to Dr. J. N. Baker, the Alabama state health officer, in order to gain approval for the study (Jones pg. 98). Dr. Clark had planned to complete the study within six to eight months, which basically made treatment a pointless effort when the current treatment duration was over one year long (Jones pg. 99).

The lesson public administrators should gain from reading this book is the deceitfulness that exist today. Much like Dr. Clark, many individuals who are so aggressive at achieving their goals, will stop at nothing to be successful in achieving those goals. Public Administrators should pay close attention to the tasks they are involved in, and always remember to â€œstep backâ€ and look at the â€œbig picture.â€ These lessons learned are very important, especially in todayâ€™s societal values of the fair and equal treatment of mankind. With the rise of the human rights activist, and even the animal rights activist, society is now closely looking at the moral and ethical ways â€œweâ€ treat each other.

Strengths and Weaknesses

Jonesâ€™ ability to move the reader from one viewpoint to another was simply amazing. When the reader first begins to read the book, anger, confusion, hurt, and disbelief, are all synonymous of the feelings brought on through the words of the book. But as the reader continues, they are drawn to the many â€œreasonsâ€ illustrated so well throughout the book of how the PHS gained a vast array of approval throughout the study to help justify the experimentation methods used. Dr. Oliver Clarence Wenger, who was in charge of the Mississippi Wassermann survey, believed there was a cure, but that the cure was too costly (Jones pg. 57). The Wasserman test was a pigment fixation test that was developed in 1907 and was instrumental in identifying syphilis. Dr. John R. Heller, a retired PHS officer who had served as the director of the division of venereal disease between 1943 and 1948, was quick to point out that there were never any ethical questions raised, but that it was an experiment with great expectations (Jones pg. 144). Jonesâ€™ draws the reader into understanding there may have been reasons, although questionable, as to why the experiment was allowed to continue, and why so many involved never questioned ethics. As the one corner stone to the experiment, Nurse Eunice Riversâ€™, a black nurse employed by the PHS to keep track of the participants in the Tuskegee Study, never questioned the experiment because she knew of the Oslo Study which studied the effects of Syphilis in white males. â€œThis is the way I saw it: that they were studying the Negro just like they were studying the white man, see, making a comparisonâ€ said Nurse Rivers in an interview years later with Jones (Jones pg. 167). As Jonesâ€™ makes a great transition from one viewpoint to the other, the reader is bound to continue, trying to find out if there are other viewpoints that may give an ethical reasoning to the Tuskegee Study. The flow of the book, although sometimes difficult to determine the timeframe of occurrence from the different points of view, was very well organized, and was very concrete due to the numerous references included.

The Public Administrator

The student of public administration should pay close attention to the purposeful deceit, and will hopefully see the moral and ethical wrong doing which resulted in this deceit. Iâ€™m sure that many of the doctors and nurses involved in this study are now looking back at what was done, and asking themselves, â€œHow could we have done something so terrible to our fellow human being?â€ Although there will always be individuals who are so involved in the results, they will not concern themselves in the way they achieve those results. The needs of the many should outweigh the needs of the few, however, in the case of the Tuskegee Study; the only result gained was the study of how the incomplete treatment of syphilis affects the African-American male.

While reading this book, I found myself looking for the traditional, legal, ethical, and political managerial approaches to those decisions. I could not help but see each approach, except for the New Public Management (NPM) approach, displayed within the characters of the book. Of course, Iâ€™m sure the NPM approach did not exist during the term of the Tuskegee study, however, it was frightening to know that without individuals who are able to â€œsee the big pictureâ€, this study could potentially happen again, although highly unlikely due to the overall increase in knowledge of the population in general. The African-American male in Macon County who may not have even known what it meant to have syphilis (Jones pg. 5) was the responsibility of the public administrators and should have been protected, and not studied. No matter what geographical location, there will always be a race or demographic

group that may be of a lesser knowledge or understanding of a subject, but gives individuals with the understanding no right to oppose harm to them for their benefit.

Conclusion

This reversal of the role of the public administrator as a protector of the citizens, to the role of the public administrator conducting inhuman experiments (Jones pg. 11) should never be tolerated. As public administrators, we should continue to keep balance within the organization so there will never be an unbalance of power that is associated with the day and age of the Tuskegee Study. Medical scientists were rarely asked to justify their methods of experimentation (Jones pg. 97), and therefore was the main reason these experiments were allowed to continue. In addition to great sales tactics, and the uninformed subjects, this experiment was bound to continue until one man began to ask, â€œWhy?â€ As I see it, Mr. Peter Buxton, a venereal disease interviewer and investigator of the PHS in San Francisco, started the process of questioning the Tuskegee Study. Mr. Buxton can be accredited for starting the closing of this experiment, and Jones for bringing these lessons learned to the publicâ€™s attention.